New figures have revealed that almost 1000 people within the NHS Lothian region are waiting for life changing hybrid closed loop (HCL) system.
This is a devastating blow for diabetic patients who face extensive wait times to receive the technology.
Hybrid closed loop systems work to automatically adjust glucose levels depending on a patient’s blood sugar.
This is in stark contrast to the current system where the patient must manually adjust and administer the insulin themselves.
Paul Hughes, who works for Edinburgh Council and has had diabetes for 24 years, finds himself stuck on the waiting list for a HCL system.
Mr Hughes originally requested to be added to the waiting list in 2021 but found out, after inquiry, that he had not been added until 2023.
He is concerned that the ‘postcode lottery’ will mean he is not able to access an HCL system for the foreseeable future.
Mr Hughes has previously suffered a broken cheek and elbow from collapsing due to his blood sugar levels dropping too low.
He believes an HCL system is critical to improving his diabetes control and avoiding similar incidents in the future.
These figures were first revealed via FOI, by Labour MSP for Lothian, Sarah Boyack.
Ms Boyack has written an open letter (above) to Cabinet Secretary for Health, Neil Gray to ask what actions the Scottish Government is taking to urgently reduce these waiting lists.
Earlier this year, Ms Boyack hosted a roundtable of diabetic constituents who raised access to diabetes technology as a critical issue.
Commenting on these figures, Ms Boyack said: “The size of the waiting list is extremely alarming.This is life changing technology and patients across Lothian are in limbo waiting to receive it.
“I have had many constituents contact me, anxious about the lack of clarity for when they will receive an HCL system.
“The Scottish Government have announced funding to expand the HCL rollout, but it means nothing if it is not reaching people on the ground. That is why I have written to Neil Gray to ensure that type 1s across NHS Lothian are not left out in the cold when it comes to getting a HCL system”.
Paul Hughes added: “This technology would be life changing for me.I would no longer have to worry about my blood sugar dropping during the night, which currently keeps me awake.
“I am incredibly concerned about the long waiting list for those in NHS Lothian.
“I have sustained serious injury from collapsing due to low blood sugar so this technology cannot come soon enough.”
An Edinburgh based diabetic patient has been told she will be not given the new closed loop diabetic pump technology, despite the fact that she has been testing the system, for the NHS since last year.
Megan Ormond, who has had diabetes for all her teenage and adult life, contacted Labour MSP, Sarah Boyack to raise her situation.
Ms Ormond was taking part in a study of the closed loop system and was told partaking in this study would likely secure her the technology faster.
However, at her last meeting, she was told, due to budget cuts, the closed loop system would not be made available to her after the study.
While using this closed loop system, her HBA1C which is used by doctors to test a patient’s glucose levels over the last 3 months, has been the lowest it has been for her entire time with diabetes.
The Scottish Government’s Diabetic Improvement Plan cites rolling out the closed loop system, as quickly as possible as a key target.
However, due to budget cuts and required savings, NHS Lothian is unable to carry out their rollout of the system at their expected rate.
NHS England began rolling out the closed loop system on the 1st April 2024.
Commenting on Megan’s case, Lothians MSP Sarah Boyack, said: “Megan’s case shows the absolutely shocking state the SNP Government has allowed NHS Lothian to fall into.
“Life changing technology and treatment are being denied to patients due to a lack of funding. That is unacceptable anywhere in Scotland, never mind our nation’s capital.
“The Scottish Government must act to ensure Megan and other diabetics are able to access this ground-breaking treatment as they were promised.
“There is real opportunity to improve the quality of life for diabetes patients in Edinburgh, but that opportunity isn’t just being denied to my constituents its being snatched away.”
A closed loop system is a game changer for T1 diabetics. One of my constituents tested this system for the NHS However, due to budget cuts the system can’t be rolled out as planned and she must revert to her old insulin pump. The SNP's cuts are rolling back these opportunities pic.twitter.com/P7i40rNDc8
Three-minute bouts of yoga have been found to significantly lower blood glucose levels and reduce the risk of diabetes, a study from Glasgow Caledonian University has revealed.
The research carried out by a team of physiotherapists, including NHS Greater Glasgow and Clyde team member, Alex Colvin, investigated the effects of breaking up sedentary behaviour with short bouts of yoga and tai-chi on glycaemic control, concentration, and wellbeing in healthy individuals.
The study, which involved 15 adults aged 26-28, found that the effects of short bouts of yoga to break up the working day significantly lowers glucose levels to reduce the risk of diabetes without compromising concentration or wellbeing.
However, tai-chi did not provide the same significant effect on glucose levels but allowed better maintenance of concentration and wellbeing. The research concluded that these interventions provide effective ways to combat the harmful effects of prolonged sitting while maintaining concentration and wellbeing.
Alex, also lead author of the study, said:“Through this research, I want to make people aware that you can break up your sedentary time with things that are good for your mental and physical wellbeing, and to reduce the risk of diabetes.
“There has been a lot of research into the benefits of yoga and tai-chi, which show favourable effects, but this is the first research that I am aware of that investigates the use of shorter three-minute bouts to break up a working day and shows results that this can help to reduce the risk of diabetes.
“This is also good news for employers who dislike the use of physical activity to break up sedentary time because they have this misplaced perception that it will negatively impact on production, as we have found it’s quite the opposite. We measured concentration and wellbeing throughout the study. Although there wasn’t a change with yoga and tai-chi, at least it didn’t get any worse, which disproves that doing these types of things is bad for worker productivity.”
Alex graduated with a Masters in Physiotherapy in 2020 from Glasgow Caledonian and became an NHS Greater Glasgow and Clyde specialist physiotherapist. He began the research during his studies with fellow students Lynne Murray and Jillian Noble, under the supervision of Professor Sebastien Chastin, but results were delayed due to the COVID-19 pandemic.
Alex explained more about the methods used in the two-year study: “We took finger-prick glucose readings every half an hour throughout a seven-hour working day and standardised the participants’ diet as much as we could, along with that we broke up the sedentary time and the groups with either three minutes of yoga or tai-chi, or just sitting for the whole time and measuring their glucose.
“Although the study involved a small number of 15 mostly healthy adults aged between 26-28, it doesn’t change the fact that the glucose levels were still lowered. By using this group it might even be more beneficial to people who are prediabetic and the results might even be more significant.”
Professor of Health Behaviour Dynamics Sebastien Chastin, from the University’s School of Health and Life Sciences’ Research Centre for Health (ReaCH), highlighted the benefits of this research study.
He said: “Clearly we all spend far too much time sitting in the office or working from home. This shows that short bouts of yoga that can be done anytime during the day and it has the impact we expected that it can be turned into one of the interventions or reduce the risk of diabetes.
“What’s also really important about this research is that it demonstrates that it doesn’t reduce the productivity of workers. That’s always the worry of the bosses. Allowing them to have that time shows that it actually doesn’t reduce productivity at all, if anything it probably increases productivity so there’s not just a health incentive for the workers to do it but also for the employers to support that and implement it.”
Researchers from Queen’s University Belfast have designed a new 3D printed bandage, known as a scaffold, which presents an innovative method of treatment to heal diabetic foot ulcers (DFUs).
The research is the first of its kind and is a breakthrough for diabetes management. The findings have been published in the journal Biomaterials Advances.
The new discovery combines lipid nanoparticles and hydrogels, which are used to create personalised skin-like 3D printed scaffolds. These scaffolds have the ability to release both a bulk and sustained release of antibiotic loaded molecules to treat diabetic ulcers.
This combination has been shown to greatly improve patient outcomes and has the added benefit of being a more sustainable, efficient and cost-effective method of treatment as these scaffolds in the future can be “easily” produced within the hospital setting.
This approach will also cut time for medical professionals and improve patient care, as the wound dressing can be monitored and provide the treatment needed without the need to be taken on and off repeatedly in order for the medical professionals to check the healing process.
The research team was led by Professor Dimitrios Lamprou from the School of Pharmacy at Queen’s University Belfast, in collaboration with Ms Costanza Fratini (Erasmus Visitor), Mr Edward Weaver (PhD Student from the School of Pharmacy at Queen’s), Dr Sofia Moroni (PhD Student between Queen’s University and the University of Urbino Carlo Bo), Ms Robyn Irwin (PhD Student from the School of Pharmacy at Queen’s), Dr Yahya Dallal Bashi (Postdoctoral Researcher from the School of Pharmacy at Queen’s), Dr Shahid Uddin (Industrial Collaborator), Professor Luca Casettari (University of Urbino Carlo Bo), and Dr Matthew Wylie from the School of Pharmacy at Queen’s.
Diabetes is a lifelong condition that causes a person’s blood sugar level to become too high. It is among the top ten causes of deaths worldwide. DFUs are a serious complication of diabetes, affecting approximately 25% of diabetic patients. When identified, over 50% are already infected and over 70% of cases result in lower limb amputation.
As a strategy to manage DFUs, skin alternatives and wound dressings are successful treatments as they keep the wound environment “under control”, whilst providing bioactive compounds that help to manage infection and inflammation and promote tissue repair.
This is a complex process that requires several combined therapeutic approaches. As a result, there is a significant clinical and economic burden associated in treating DFU. Furthermore, these treatments are often unsuccessful, commonly resulting in lower-limb amputation.
The use of drug-loaded scaffolds to treat DFUs has previously been shown to be successful by the same team. To create this new scaffold, the research team used a 3D bioprinting technique that combines, in one single filament, two different bioinks.
The inner core of the filament is a nanocomposite hydrogel that contains lipid nanoparticles encapsulated with thyme oil. The outer shell of the filament is represented by a hybrid hydrogel and enriched with free thyme oil. Thyme oil and other essential oils, have a promising future as an all-natural antibiotic replacement, helping address the issue of increasing incidences of antimicrobial resistance.
This combination provides two different release ratios of the drug molecule; a bulk release for the first 24 hours and a sustained release for up to 10 days. This enables an initial disease prevention post-administration, which may be the highest-risk time, followed by sustained infection prevention during the following days of antimicrobial efficacy.
Commenting on the importance of this study, Professor Dimitrios Lamprou, lead on the project and Chair of Biofabrication and Advanced Manufacturing from the School of Pharmacy at Queen’s University Belfast, said: “This innovative, personalised, and sustainable approach, provides the healing needed for the diabetic foot ulcers, to avoid any complications, and enables doctors to monitor the healing constantly.
“This avoids needing to remove dressing constantly, which can provoke infection and delay the healing process. Medical professionals also do not need to change the drug dosage as this double release, supports that need.”
Dr Matthew Wylie, Lecturer from the School of Pharmacy at Queen’s University Belfast and responsible for the in vitro antibacterial activity evaluation of these novel bandages, said: “Diabetic foot ulcers are chronic wounds highly susceptible to infection which can lead to limb- or life-threatening complications.
“Our natural liposomal antibacterial approach has shown promising initial antibacterial results highlighting the potential of this strategy to prevent bacterial colonisation during the crucial early stages of wound healing, as well as longer term protection of the wound.
“Improved wound management will not only enhance patient quality of life but could reduce the need for traditional antibiotic therapy, a key aim in the fight against antimicrobial resistance development.”
Life-changing technology that reduces the risk of complications for people with type 1 diabetes will become more widely available thanks to additional funding.
The Scottish Government has invested a further £350,000 to accelerate the distribution of Closed Loop Systems. The technology is considered the most significant development in type 1 diabetes treatment in recent years and can transform lives, particularly for children and young people.
Closed Loop Systems help people improve their glycaemic control and in turn reduce the likelihood of complications, which at their most serious can include blindness, renal failure, and amputations; as well as unplanned admissions to hospital.
The investment will see a dedicated team created by the national Centre for Sustainable Delivery at NHS Golden Jubilee to support NHS health boards to rollout the technology faster and more efficiently across Scotland.
Public Health Minister Jenni Minto said: “There’s no reason why someone living with type 1 diabetes shouldn’t live a long and healthy life, but some people find managing their condition difficult.
Diabetes technologies make the process easier and can enhance people’s quality of life. That’s why we’re aiming to provide access to Closed Loop Systems at the earliest opportunity and are working with NHS boards to improve access.”
National Diabetes Lead Professor Brian Kennon said: Closed Loop systems are truly transformative technologies and help reduce the day-to-day burden of trying to optimise type 1 diabetes control.
“Creation of a dedicated team to help support the adoption of Closed Loop Systems and standardise our approach to access across Scotland will help ensure that our healthcare system is well placed to realise the massive advantages that these innovative technologies offer.”
Researchers at Queen’s University Belfast have designed a new bandage treatment, known as a scaffold, to treat diabetic foot ulcers, which is cost-effective while improving patient outcomes. Produced by 3D bioprinting, the scaffolds slowly release antibiotics over a four-week period to effectively treat the wound.
Diabetes, a lifelong condition that causes a person’s blood sugar level to become too high, is among the top ten causes of deaths worldwide.
Diabetic foot ulcer (DFU), is a serious complication of diabetes, affecting approximately 25% of diabetic patients. When identified, over 50% are already infected and over 70% of cases result in lower limb amputation.
The treatment strategy required for the effective healing of DFU is a complex process that requires several combined therapeutic approaches. As a result, there is a significant clinical and economic burden associated in treating DFU. These treatments are often unsuccessful, which leads to lower-limb amputation.
This new research demonstrates outcomes with significant implications for patient quality of life, as well as decreasing the costs and clinical burden in treating DFU.
Recent research has focused on drug-loaded scaffolds to treat DFU. The scaffold structure is a novel carrier for cell and drug delivery that enhances wound healing.
The research, published in Springer Link, will be presented by Professor Lamprou at the Controlled Release Society (CRS) Workshop Italy (7 – 9 October).
Professor Dimitrios Lamprou, a Professor of Biofabrication and Advanced Manufacturing at Queen’s School of Pharmacy and corresponding author, explains: “These scaffolds are like windows that enable doctors to monitor the healing constantly. This avoids needing to remove them constantly, which can provoke infection and delay the healing process.
“The ‘frame’ has an antibiotic that helps to ‘kill’ the bacteria infection, and the ‘glass’ that can be prepared by collagen/sodium alginate can contain a growth factor to encourage cell growth. The scaffold has two molecular layers that both play an important role in healing the wound.”
Lead author Ms Katie Glover, from the Queen’s School of Pharmacy, concludes: “Using bioprinting technology, we have developed a scaffold with suitable mechanical properties to treat the wound, which can be easily modified to the size of the wound.
“This provides a low-cost alternative to current DFU treatments, which could revolutionise DFU treatment, improving patient outcomes while reducing the economic burden caused by rapidly increasing patient demand as the number of people with diabetes continues to increase every year.”
Researchers at Queen’s University Belfast have uncovered a key process that contributes to vision loss and blindness in people with diabetes. The findings could lead to new treatments that can be used before any irreversible vision loss has occurred.
Diabetic retinopathy is a common complication of diabetes and occurs when high blood sugar levels damage the cells at the back of the eye, known as the retina. There are no current treatments that prevent the advancement of diabetic retinopathy from its early to late stages, beyond the careful management of diabetes itself. As a result, a significant proportion of people with diabetes still progress to the vision-threatening complications of the disease.
As the number of people with diabetes continues to increase globally, there is an urgent need for new treatment strategies, particularly those that target the early stages of the disease to prevent vision loss.
The retina demands a high oxygen and nutrient supply to function properly. This is met by an elaborate network of blood vessels that maintain a constant flow of blood even during daily fluctuations in blood and eye pressure. The ability of the blood vessels to maintain blood flow at a steady level is called blood flow autoregulation. The disruption of this process is one of the earliest effects of diabetes in the retina.
The breakthrough made by researchers at Queen’s University Belfast pinpoints the cause of these early changes to the retina.
The study, published in the US journal JCI Insight, has discovered that the loss of blood flow autoregulation during diabetes is caused by the disruption of a protein called TRPV2. Furthermore, they show that disruption of blood flow autoregulation even in the absence of diabetes causes damage closely resembling that seen in diabetic retinopathy.
The research team are hopeful that these findings will be used to inform the development of new treatments that preserve vision in people with diabetes.
Professor Tim Curtis, Deputy Director at the Wellcome-Wolfson Institute for Experimental Medicine at Queen’s and corresponding author, explains: “We are excited about the new insights that this study provides, which explain how the retina is damaged during the early stages of diabetes.
“By identifying TRPV2 as a key protein involved in diabetes-related vision loss, we have a new target and opportunity to develop treatments that halt the advancement of diabetic retinopathy.”
The study was funded by the Biotechnology and Biological Sciences Research Council and the Department for the Economy Postgraduate Studentship scheme.
A new clinical trial researching treatment for patients with sight loss as a result of diabetes has shown a type of laser treatment to be both cost effective and non-invasive, offering the best option for patients and healthcare providers.
There are currently several treatment options offered to people with Diabetic Macular Oedema (DMO), including two types of laser treatment and eye injections. DMO is the most common sight-threatening complication of diabetes, affecting over 27 million adults. This new research provides much-needed evidence to enable patients and healthcare professionals to be better informed on treatment options.
DMO happens when blood vessels in the retina at the back of the eye leak, causing fluid build-up at the macula, which provides central vision. The leakage occurs when high blood sugar levels damage blood vessels.
The severity of DMO is most often determined by measuring the thickness of the macula, which in-turn will determine the treatment offered. Patients with more severe DMO (with thickness of 400 microns or more) are treated with injections into the eye of drugs, known as anti-VEGFs.
Patients with mild DMO (with thickness of less than 400 microns) can be treated with macular lase, which can be standard threshold laser or subthreshold micropulse laser. The former produces a burn or scar on the retina. The latter, which is a more recent technology, works without leaving a burn or scar or any type of visible change or mark on the retina.
The research, published in Ophthalmology, found that subthreshold micropulse laser, which does not create a burn on the retina, was effective in maintaining a patient’s vision. This also requires much less frequent visits to the clinic and is much more cost effective than treatment via eye injections, with eye injections costing almost ten times more than laser treatments.
Professor Noemi Lois, Clinical Professor of Ophthalmology at Queens University and Honorary Consultant Vitreoretinal Surgeon at the Belfast Health and Social Care Trust and lead author on the study, explains: “The absence of a scar or burn following subthreshold micropulse laser led to some healthcare professionals to doubt its effectiveness compared to the standard threshold laser.
“However, our research addressed this by demonstrating that subthreshold micropulse laser is as good as standard threshold laser for helping people’s vision, reducing macula thickness, allowing people to meet driving standards, and maintaining their quality of life, both in general terms and for vision in particular.”
The research team set out to compare both types of available laser treatment through a large randomised clinical trial, known as DIAMONDS (DIAbetic Macular Oedema aNd Diode Subthreshold micropulse laser SML). They recruited 266 patients across 16 NHS hospitals around the UK, with half receiving standard threshold laser and the other half receiving subthreshold micropulse laser. Unique to this trial, patients were involved in selecting the outcomes, including how driving standards would be met following treatment. At the end of the two-year trial, DIAMONDS found both laser treatments to offer equivalent benefits.
The total cost of the care of patients enrolled in the trial (including the laser treatment and any other treatments required as well as the costs of the follow-up visits) over two years was similar for both patient’s groups. Over the two-year period, the cost per patient was just under £900 (£897.83) for patients in the subthreshold micropulse laser arm of the trial compared to £1125.66 for those in the standard laser arm.
Professor Lois adds: “Some ophthalmologists advise patients with milder forms of DMO to have injections of anti-VEGFs, rather than laser, despite laser being less invasive and requiring less visits to the clinic.
“Laser treatment costs significantly less than eye-injections of anti-VEGFs. With an average of ten injections required over two years, the total cost of eye injections per patient amounts to approximately £8,500 for the drug alone. This is almost ten times the cost of subthreshold micopulse laser without taking into account additional costings such as staff time.
“Until we published these findings, there was no robust evidence comparing these types of laser treatments. A lack of information led some healthcare professionals to favour standard laser over subthreshold micropulse laser. We now have robust evidence to show that both laser treatments are not only effective in clearing the fluid from the retina and maintaining vision for at least two years, but both are also cost-effective.”
“Armed with this knowledge, it’s likely that patients will opt for micropulse subthreshold laser, which doesn’t burn the retina and is comparable to standard laser. Whilst we didn’t directly compare laser treatments to treatment via eye injections of anti-VEGFs, hopefully we have shown that laser is an effective treatment, while remaining much less invasive to the patient and much less costly to the NHS.”
The research was funded by the Health Technology Assessment (HTA) of the National Institute for Health and Care Research (NIHR).
As the covid crisis eases, the national sight loss charity RNIB Scotland is emphasising it is more important than ever that people with diabetes attend their regular eye-examinations now that these have resumed.
During Diabetes Week this week [June 13-19th], the charity is pointing out that diabetic retinopathy, a complication of the condition, is a leading cause of sight loss among working-age Scots.
Director James Adams said: “Diabetic retinopathy, a complication of diabetes, can affect the small blood vessels at the back of the eye and is a major cause of sight loss among working-age adults. But damage to vision can be arrested if detected early enough.
“While it’s possible that diabetes won’t cause any changes to your vision, the most effective thing you can do to prevent sight loss is to go to your retinal screening appointments and eye examinations, where safety measures are in place.”
Each year, 5,500 patients with diabetes in Scotland need to undergo further imaging or see an NHS eye specialist for the first time due to worsening in their retinopathy.
Angela Clelland, 47, from Inverness received a diagnosis of diabetic retinopathy during lockdown.
“Getting diagnosed was very, very scary,” Angela said, “because I was isolated in the pandemic. If you are on your own, it affects everything from simple things like making a cup of tea, having the confidence to go out, or not being able to check your diabetes because you can’t read the monitor.
“You need to take your eye health seriously. You need to make sure that you are going for your eye health checks. Even with the slightest change, go to your optician. As things were delayed due to COVID, I would urge anybody who is maybe late or due an appointment to go and make one, because the effect on your life if you don’t go and something happens is devastating.”
There are 3.5 million people in the UK who have been diagnosed diabetes, and an estimated 500,000 people living with undiagnosed diabetes. Within 20 years of diagnosis, nearly all people with type 1 diabetes and almost two-thirds of people with type 2 diabetes will have developed some form of diabetic retinopathy. People with diabetes are also at increased risk of glaucoma and cataracts.
People from a South Asian or African-Caribbean background are two to four times more likely to get type 2 diabetes. They tend to develop it at a younger age which means they live with the condition for longer.
The risk of complications increases with the length of time people have the condition. It is not known why this is the case, but it is likely to be a mixture of genetics, lifestyle, and environmental factors.
* If you’re worried about your vision, contact RNIB’s Sight Loss Advice Service on 0303 123 9999 or visit www.rnib.org.uk/eyehealth.
For more information on the NHS Scotland eye-screening service, visit:
